title: Nutritional management of acute pancreatitis: the concept of 'gut rousing'.
abstract: OBJECTIVE
  Enteral nutrition has emerged as one of the most effective treatments in the early management of patients with acute pancreatitis. The original rationale for nutrition in acute pancreatitis, dating back to the mid-20th century, was to provide full nutritional requirements but avoid stimulating exocrine pancreatic secretion. The purpose of this article is to review the recent clinical studies of enteral nutrition in acute pancreatitis to revise the rationale and develop a contemporary conceptual framework for nutritional management of this disease.
  
  
  RESULTS
  Several recent randomized controlled trials dispel the outdated concept of 'pancreatic rest', which equates with gut neglect, and offer 'gut rousing' as a preferred concept. The new concept postulates that gastrointestinal (dys)function has a discernible impact on the outcomes of patients with acute pancreatitis. Further, timely administration of appropriate intraluminal modalities prevents or mitigates the gastrointestinal dysfunction.
  
  
  CONCLUSIONS
  Nutritional management in acute pancreatitis should aim primarily at maintaining the gastrointestinal function. Providing full nutritional requirements and avoiding pancreatic exocrine stimulation should be considered as secondary aims.
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand. max.petrov@gmail.com
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D000208:Acute Disease; D004750:Enteral Nutrition / Q000379:methods*; D041981:Gastrointestinal Tract / Q000378:metabolism; D006801:Humans; D009751:Nutritional Requirements; D046790:Pancreas, Exocrine / Q000378:metabolism; D010195:Pancreatitis / Q000178:diet therapy*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome